Organization
DAYTON CHILDRENS DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA ANN GRAMMER (DISTRICT MANAGER)
(615) 881-3808
Entity
Organization
Contact information
Practice address
4257 W 3RD ST, DAYTON, OH 45417-1406
(937) 268-1665
Mailing address
324 22ND AVE N, NASHVILLE, TN 37203-1842
(615) 321-6176
(615) 321-3175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS4614
TN
Other
Enumeration date
08/19/2014
Last updated
01/22/2015
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